The lungs are covered by a thin layer of lining known as the pleura. Any inflammation of this layer is termed pleurisy or pleuritis. The association of pleurisy with an underlying respiratory disease is quite common. For instance, pleurisy is often associated with respiratory neoplastic conditions, tuberculosis, SLE (systemic lupus erythematosus), and other causes.

For medical students who are preparing for the NEET PG exam, it is crucial to understand about the concept of pleurisy. This article covers all the major aspects of pleurisy, such as its causes, signs and symptoms, diagnostic approach, and treatment modalities.

Keep reading for a detailed insight into pleurisy. 

What is Pleurisy?

Pleurisy, by definition, is the inflammation of the pleura, which can result in intense chest pains. The pleura is further subdivided into layers: the parietal and visceral layers. The parietal layer is the outside layer, whereas the visceral layer lies on the inside, in contact with the lungs. 

The space between these two layers, the pleural space, contains fluid that ensures smooth expansion while inspiration. When the pleura gets inflamed, these layers rub against each other, which is the cause of the sharp pain.

What are the Causes of Pleurisy?

The most common causes of pleurisy include infectious agents like viruses, bacteria, and other pathogens. The other causes of pleurisy include:

• Autoimmune Diseases

These include conditions in which the immune system of the body attacks the normal body cells. Diseases like systemic lupus erythematosus, rheumatoid arthritis, or familial Mediterranean fever can cause pleurisy.

• Lung Diseases

Diseases directly affecting the lungs can cause pleurisy. These diseases include lung cancer, mesothelioma, tuberculosis, asbestosis, etc.

• Drugs

Certain drugs, isoniazid, hydralazine, and procainamide, lead to inflammation of the pleura.

• Trauma

Any form of trauma or thoracic surgical intervention can lead to inflammation of the pleura.

• Other Causes

Some of the other causes leading to pleurisy can include sickle cell disease, inflammatory bowel disease, and pulmonary embolism.

What are the Symptoms of Pleurisy?

The characteristic feature of pleurisy is the intense chest pain. The nature of pain is sharp, stabbing, and localised. The pain usually aggravates while inspiring or coughing, and can radiate to the shoulders and the back. The other pleurisy symptoms include:

• Breathlessness
• Cough
• Fever
• Fatigue

What is the Diagnosis of Pleurisy?

At first, a physician will initially ask a few questions regarding the medical history and perform a physical examination, including auscultation of the chest with a stethoscope. To find out whether you have pleurisy and why it is developing, the doctor may suggest some tests:

• Blood Tests

A blood test may uncover a sign of an infection. Further blood tests may uncover an autoimmune illness, such as rheumatoid arthritis or lupus. In these instances, pleurisy is the presenting symptom.

• Chest X-Ray

A chest X-ray will show if the lungs are taking up the entire space or if there is air or fluid in the area between the lung and the ribcage.

• CT Scan

Computed tomography (CT) scan is an imaging technique that is composed of a sequence of X-rays. The method employs computational algorithms in order to compose cross-sectional images in the form of parts of the thoracic region. 

These high-resolution images are capable of illustrating the condition of the pleura. They can also explain other pain causes, such as the development of a pulmonary embolism.

• Ultrasound

Ultrasound is a radiologic imaging modality that uses high-frequency sound to develop detailed images of inner body structures. The technique can be used to evaluate for evidence of a pleural effusion.

• Electrocardiogram

Electrocardiogram (ECG or EKG). This heart monitoring test may be suggested to rule out certain heart diseases as the cause of your pleurisy chest pain.

In a few instances, a health worker may aspirate tissue and fluid from the pleural space for laboratory tests. These tests may include:

• Thoracentesis

Thoracentesis is a procedure where a local anesthetic is injected between the ribs where fluid has been localised on imaging tests. A needle is then inserted through the chest wall, between the ribs, to drain fluid to be sent to the lab for analysis. 

Fluid removal can also lead to improvement in pulmonary function. Insertion of the needle is frequently done under ultrasound supervision.

• Thoracoscopy 

If there is a suspected neoplastic disease or tuberculosis, a thoracoscopy or pleuroscopy can be performed. Under this, a very small camera called a thoracoscope is inserted through a small incision in the chest wall. This allows direct visualisation within the thoracic cavity to reveal possible problems or to obtain a tissue sample for biopsy.

What is the Treatment for Pleurisy?

Pleurisy treatment modality depends upon the cause of the disease. Depending on the cause, the healthcare professionals suggest the appropriate treatment method. These can include:

1. Antimicrobials

These drugs help to tackle the infectious agents that cause pleurisy. It is prescribed in case of bacterial, viral, or fungal infections.

2. Analgesics

In case of extreme pain, the doctors can advise you to take some pain medications that usually include NSAIDs (non-steroidal anti-inflammatory drugs) or corticosteroids.

3. Thoracocentesis

The advantage of thoracocentesis is that it is both a diagnostic and a therapeutic procedure.

What are the Preventive Measures for Pleurisy?

Prevention of pleurisy usually includes simple lifestyle modifications. The modifications include:

• Cessation of smoking or abstaining from smoking
• Treatment of the underlying cause
• Maintenance of hygiene
• Timely health checkups
• Moderate exercise daily

What are the Complications of Pleurisy?

Pleurisy usually leads to various complications like pleural effusion, atelectasis, and empyema. These conditions have been described below:

1. Pleural Effusion

Occasionally, pleurisy can lead to excessive fluid accumulation in the pleural space. This is known as pleural effusion. In case of lesser amounts of fluid in the space, the pain usually diminishes. This is due to the adequate distance between the two layers, preventing friction.

2. Atelectasis

The excess fluid buildup can lead to partial or complete collapse of the lungs due to intense pressure.

3. Empyema

Empyema is a condition in which the pleural fluid becomes infected. Pleurisy can also cause empyema.

FAQs about Pleurisy

1. What are the different causes of pleurisy?

Pleurisy can have varying causes, from pathogens like viruses to autoimmune conditions like SLE, FMF (familial mediterranean fever), and others. There are many miscellaneous causes of pleurisy like, lung tumours, surgical procedures, trauma, etc.

2. Is pleurisy self-healing?

Usually, pleurisy slowly resolves on its own. However, if complications develop, professional care is required.

3. What is the characteristic symptom of pleurisy?

Pleurisy presents with a characteristic sharp, localised pain that increases while breathing.

4. How is pleurisy treated?

The treatment of pleurisy includes antibiotics, analgesics, and thoracocentesis, depending on the cause and the extent of the disease.

5. Can pleurisy be a chronic disease?

Generally, pleurisy is a non-fatal disease, and you can still live a long life with it. However, the complications of pleurisy can be fatal if left untreated.

Conclusion

Pleurisy is a condition that warrants immediate intervention. It is extremely crucial to look out for the signs and symptoms. Pleurisy is also an important topic for the upcoming NEET PG examination. 

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